Healthcare Provider Details

I. General information

NPI: 1215288022
Provider Name (Legal Business Name): SARA F CLAYCOMB AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SARA F MOSEY AU.D.

II. Dates (important events)

Enumeration Date: 09/20/2012
Last Update Date: 04/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

676 N SAINT CLAIR ST STE 1325
CHICAGO IL
60611-2927
US

IV. Provider business mailing address

675 N SAINT CLAIR ST STE 15-200
CHICAGO IL
60611-5967
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-0665
  • Fax: 312-695-0050
Mailing address:
  • Phone: 312-695-8107
  • Fax: 312-695-6850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAU2829
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberHA7735
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number147001403
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: